BC Advantage

Physician Signatures on Test Requisitions: CMS Clarifies Medicare Policy - July, 2008
Has your laboratory received documentation requests from the comprehensive error rate testing (CERT) contractor (AdvanceMed) asking for an original requisition signed by the ordering physician? If so, you're not alone. According to a letter from the American Clinical Laboratory Association (ACLA) to the Centers for Medicare & Medicaid Services (CMS) in mid-March, many laboratories have received such requests. What's more they received notification that the testing is inappropriate, and the claim will be denied if no such requisition can be produced. (Don't panic! It's not true.)
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Codes Subject to CLIA Edits in 2008: CMS Issues a List of Eight Codes - July, 2008
As you probably know, the CPT codes that CMS considers to be laboratory tests under CLIA, which require a certification, change each year. In Transmittal 1471 (February 29), CMS informed Medicare carriers and Part A/B Medicare administrative contractors (MACS) about the 2008 codes that are subject to CLIA edits and also about those that are now excluded from CLIA edits.
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Billing Emend® Tri-Pak on Outpatient Claims: Clarifications Issued on Wrongful Denials - May, 2008
It has come to the attention of the Centers for Medicare & Medicaid Services (CMS) that payment denials are occurring for the three-drug combination of oral anti-emetics contained in the Emend Tri-Pak because two doses of anti-emetics are sent home with the patient. The denial of these claims resulted from a misinterpretation by the Medicare fiscal intermediaries (FIs) of a policy concerning the billing of take-home drugs.
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Ordering Diagnostic Tests in Non-Hospital Settings: CMS Discovers and Issues Missing Guidelines - March, 2008
Although it's been several years since the Centers for Medicare & Medicaid Services (CMS) transitioned from the Medicare Carriers Manual (MCM) to the Internet-only manual, it has just gotten around to incorporating language it says it "inadvertently omitted" related to the requirements for ordering, and following orders for, diagnostic tests in non-hospital settings.
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